Clinical examination is an inaccurate predictor of intraabdominal pressure

Sugrue, Michael; Bauman, Adrian; Jones, F.; Bishop, Gillian; Flabouris, Arthas; Parr, Michael; Stewart, Antony; Hillman, Ken; Deane, S. A.

doi:10.1007/s00268-002-6411-8

Cited by 230 publications

(104 citation statements)

References 26 publications

(19 reference statements)

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“…A laparotomia descompressiva é considerada o único tratamento definitivo, sendo atualmente defendida também a utiliza-ção de estratégias medicamentosas na prevenção das disfunções ou falências de órgãos, com utilização principalmente de diuréticos e colóides (Sugrue et al 2002, Tiwari et al 2002, Cheatham et al 2007.…”

Section: Introductionunclassified

Pressão intra-abdominal em cães

Gonçalves¹,

Wouk

Mira³

2011

Pesq. Vet. Bras.

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812Pesq. Vet. Bras. 31(9):812-816, setembro 2011 RESUMO.-Sob consenso recente em pacientes humanos, os valores basais da pressão intra-abdominal (PIA) e seus prováveis limiares em casos mórbidos, foram estipulados com intuito de favorecer a homogeneidade de estudos científicos, além de fornecer diretrizes para conduta diagnóstica e terapêutica destes pacientes. Valores basais e alterações na pressão intra-abdominal em animais não são ainda suficientemente conhecidos e cientificamente determinados. Médicos veterinários necessitam conhecer melhor os estados mórbidos que cursam com Hipertensão Intra-Abdominal (HIA) ou Sín-drome de Compartimento Abdominal (SCA). O presente estudo objetivou testar em cães a técnica já descrita sob consenso na medicina como modelo de mensuração da pressão intra-abdominal, assim como determinar os valores normais para a espécie. Foram utilizados 15 cães hígidos, machos e fêmeas, homogêneos e todos sem raça definida. A mensuração da pressão intra-abdominal foi realizada por meio da téc-nica indireta de sondagem vesical e utilização de coluna de água com régua graduada em cm de H 2 O, sendo seu valor final convertido para a unidade de mm de Hg. In order to favor the homogeneity of scientific studies and to provide guidelines on the diagnosis and therapy, human basal values of the intra-abdominal pressure (IAP) and their probable thresholds in morbid cases were recently established. However, basal values and changes in the intra-abdominal pressure in animals are still partly unknown and not scientifically confirmed. Veterinarians have the need to expand their knowledge on morbid conditions that develop with Intra-Abdominal Hypertension (IAH) or Abdominal Compartment Syndrome (ACS). The present study aims to test in dogs the technique adopted in human medicine as a model for measurement of intra-abdominal pressure (1) and determine normal values for the species (2). Fifteen known mongrel healthy dogs, males and females and homogenous were tested. The measurement of IAP was done through an indirect technique which involves catheterizing the bladder and using a water column with a graduate ruler in cm of H 2 0 -its final value converted to mm of Hg. The values observed ranged from a minimum sub atmospheric value (below of zero mm of Hg) to 3,75 mmHg. There was a considerable variation within the individual values observed in some animals, bringing up considerations related to body mass, frequency/total volume of the physiologic solution to be administered and inquietude of these dogs during the treatment. The thresholds values found are considered physiologic, indicating reliability of the technique and possibility of its clinical use. The absence of sedation and the use of urethral catheter did not compromised the measurement, however could have resulted in under-or overestimation of the values found.

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Section: Introductionunclassified

Pressão intra-abdominal em cães

Gonçalves¹,

Wouk

Mira³

2011

Pesq. Vet. Bras.

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“…More recently, Soler Morejon et al identified the importance of the zero reference level and its impact on IAP measurement in surgical patients after abdominal surgery [17]. A clinical examination is not a reliable indicator of IAP [18,19]. The abdominal perimeter also correlates poorly with IAP [20].…”

Section: Factors Affecting Iap Measurementmentioning

confidence: 99%

A user’s guide to intra-abdominal pressure measurement

Sugrue

Waele²,

Keulenaer³

et al. 2015

Anaesthesiol Intensive Ther

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The intra-abdominal pressure (IAP) measurement is a key to diagnosing and managing critically ill medical and surgical patients. There are an increasing number of techniques that allow us to measure the IAP at the bedside. This paper reviews these techniques. IAP should be measured at end-expiration, with the patient in the supine position and ensuring that there is no abdominal muscle activity. The intravesicular IAP measurement is convenient and considered the gold standard. The level where the mid-axillary line crosses the iliac crest is the recommended zero reference for the transvesicular IAP measurement; moreover, marking this level on the patient increases reproducibility. Protocols for IAP measurement should be developed for each ICU based on the locally available tools and equipment. IAP measurement techniques are safe, reproducible and accurate and do not increase the risk of urinary tract infection. Continuous IAP measurement may offer benefits in specific situations in the future. In conclusion, the IAP measurement is a reliable and essential adjunct to the management of patients at risk of intra-abdominal hypertension.

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“…Physical examination has little importance in the detection of IAH and it is a poor predictor of ACS [7,23]. Imaging with chest radiography to recognize decreased lung volumes, atelectasis or elevated hemi diaphragms, or the use of computed tomography (CT) to detect infiltration differences between the retroperitoneal and peritoneal cavity or extrinsic compression of the inferior vena cava or abdominal distension, are also not helpful in the diagnosis of ACS [24,25].…”

Section: Iap Measurementmentioning

confidence: 99%

Validation of a novel method for measuring intra-abdominal pressure and gastric residual volume in critically ill patients

Stappen¹,

Pigozzi²,

Tepaske³

et al. 2014

Anaesthesiol Intensive Ther

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Background: Gastric residual volume (GRV) can be measured in a variety of ways in critically ill patients, most often, the nasogastric tube is disconnected and the GRV is aspirated via a 60 mL syringe. Bladder pressure (IBP) measurement is the gold standard for intra-abdominal pressure (IAP) estimation. This study will look at the validation of a novel method combining measurement of GRV and estimation of IAP via intra-gastric pressure (IGP). Methods: In total 135 paired IAP and 146 paired GRV measurements were performed in 37 mechanically ventilated ICU patients. The IAP was estimated via the bladder (i.e. IBP) using the FoleyManometer and via the stomach (i.e. IGP) with the new device. The GRV was measured with the new device (GRV prototype ) and via the classic method (GRV classic ). The devices were provided by Holtech Medical (Charlottenlund, Denmark) and data were retrospectively analysed. Results: The number of paired measurements in each patient was 4 ± 1. The mean IBP was 10.7 ± 4.1 and mean IGP was 11.6 ± 4.1 mm Hg. Correlation between the IBP and IGP was significant, however moderate (R 2 = 0.51). Analysis according to Bland and Altman showed a bias and precision of 0.8 and 2.7 mm Hg respectively, however the limits of agreement (LA) were large and ranged from −4.5 to 6.1 mm Hg. Changes in IGP correlated well with changes in IBP. The median GRV prototype was 80 mL (0-1050) and equal to the median GRV classic of 80 mL (0−1250). Correlation between the 2 methods was excellent (R 2 = 0.89). Analysis according to Bland and Altman showed a bias and precision of -0.8 and 52.3 mL respectively and the LA ranged from -103 to 102 mL. Changes in GRV classic correlated well with changes in GRV prototype . Conclusions:The results of this multicentre pilot study show that GRV can be measured with the new device. Furthermore this allows simultaneous screening for intra-abdominal hypertension with IAP estimation via IGP.

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Clinical examination is an inaccurate predictor of intraabdominal pressure

Cited by 230 publications

References 26 publications

Pressão intra-abdominal em cães

Pressão intra-abdominal em cães

A user’s guide to intra-abdominal pressure measurement

Validation of a novel method for measuring intra-abdominal pressure and gastric residual volume in critically ill patients

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